Article - Things to Know About Medicare Advantage

Every citizen in the US when turning 65 and/or are eligible for Medicare, need to opt for healthcare plans like traditional Medicare (Parts A and B), prescription drug coverage (Part D), supplemental coverage to pay for additional costs not covered by traditional Medicare, or whether they will get coverage through Medicare Advantage (Part C). With continuous rising healthcare costs, choosing the wrong plan can mean paying far more than you need to for medical care during retirement.

Through the Medicare Modernization Act of 2003, Medicare not only incorporated a prescription drug benefit plan (Part D) but also expanded the Medicare managed care program (Medicare + Choice) through the new Medicare Advantage (MA) program.

You will get to know more about the Medicare Advantage (MA) program as well as certain important things about MA in this brief.

Do you know Medicare Advantage Plans?

Medicare Advantage plans offer a way to get your Medicare Part A and Part B coverage; they are also called Part C” or MA Plans”.MA plans are provided by Medicare-approved private companies and these companies need to follow rules set by Medicare.

Moreover, it is observed that MA plans have drug coverage (Part D). The good thing about this plan is, it sets a limit on what you’ll have to pay out-of-pocket each year for covered services and to protect you from unexpected costs.

However, some plans offer out-of-network coverage, but sometimes at a higher cost. In many cases, you need to go for providers who participate in the plan’s network and service area for the lowest costs.

This could be the reason that nearly 18 million people out of the 56 million enrolled in a Medicare-based plan have opted for a Medicare Advantage plan.

Here are some of the key things you should know about this increasingly popular option to help decide if it's right for you.

How to join a Medicare Advantage Plan?

Every MA plan has its way of working hence before you join, take the time to find and compare Medicare health plans in your area.

Once the beneficiary understands the plan's rules and costs, here's how to join?

  • Use Medicare's, Plan Finder.
  • Visit the plan's website to see if the beneficiary can join online.
  • Fill out a paper enrollment form.
  • Contact the plan to get an enrollment form, fill it out, and return it to the plan. All plans must offer this option.

Beneficiary still get complete Part A and Part B coverage through the plan

As you have already read above, all Medicare Advantage plans cover Medicare Part A (hospital care) and Medicare Part B (medical care). Additionally, even if you're enrolled in a Medicare Advantage plan and not original Medicare, original Medicare will step in and cover your hospice care. This plan offers protection against paying excessive costs for some services under Plan C.

For example, your Medicare Advantage plan can't charge you more than the original Medicare would bill for dialysis, chemotherapy, or skilled nursing care, etc.

Medicare Advantage plans are regulated by Medicare

All MA plans are regulated by Medicare and MA plan providers must follow a set of rules issued from Medicare. Hence even though your benefits will be administered by a private insurance company. You still have Medicare rights and protections, including the right to appeal a coverage decision.

Limit to annual out-of-pocket cost

You know that original Medicare covers 80% of your medical expenses and the rest must be falling on the consumer's shoulder. If the patient will opt for cancer treatment with a new drug, then it costs the consumer much higher. That’s where a Medicare Advantage plan is useful.

Possibility for two premiums with a Medicare Advantage plan

The premium for some Medicare Advantage plans can be $0. However, many Medicare Advantage plans have a monthly premium that you must pay to be covered by the plan. In addition to the Medicare Advantage premium, you are also responsible for your Medicare Part B premium which you pay to the government.

Smaller network hospitals and physicians

In the MA plans beneficiaries' medical care choices are narrower due to a smaller handful of physicians and hospitals being contracted. While original Medicare is a massive government-sponsored plan, and as such, it is accepted by over 90% of hospitals and physicians around the country. Because your plan is offered by a private insurer, both the price and the approved physicians within the network can change annually.


Published By - Medical Billers and Coders
Published Date - Jun-11-2021 Back

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